Portugal will begin a new phase in the fight against the COVID-19 pandemic. From midnight this Wednesday to Thursday, the country will enter the mitigation phase and follow the new rules outlined by the DGS (which can see on this link). The authorities now recognize that there is “local transmission in a closed environment”, there is “community transmission” and that the plans outlined so far are no longer enough to stop the outbreak in the country. We must take the step forward. But what step is that?
https://www.youtube.com/watch?v=O5dk3b0b4y8
Just have a fever, persistent cough or difficulty breathing
COVID-19 disease suspects are considered to be all cases where a body temperature of 38ºC or more, persistent cough or difficulty breathing. In this case, people must call the Health Line 24 to be followed up.
Until now, the Directorate-General for Health (DGS) has also considered a suspicious case to be someone who has “sudden onset of fever or cough or difficulty breathing” for no apparent reason, but this situation had to be associated with one of three risk situations:
- he was considered a suspected patient only if these symptoms had appeared up to 14 days after a trip or residency in areas with “active community transmission” (such as Madrid or Lombardy, for example);
- if you were in contact with a confirmed or probable case of SARS-CoV-2 infection two weeks before your first symptoms;
- or if the clinical picture was significant enough to require hospitalization.
Four things can happen after evaluating the Health Line 24. The suspect patient can be isolated in the home and under the supervision of health authorities, be evaluated by a doctor in the area dedicated to COVID-19 at a health center, be referred for evaluation in the emergency room of a hospital or be assisted by the Guidance Centers Urgent Patients (CODU) or by INEM, which will then take them to a hospital.
This mode of action is also different from what has been followed until now. Before changing the rules, whether the user was assisted in person at an emergency center, or contacted Health Line 24 first, DGS first activated the reference hospital, INEM, a diagnostic laboratory and the regional health authority. Then, the regional health delegate informed the local health delegate to investigate other cases of possible contagion related to that user.
All suspected patients should be tested for the new coronavirus, SARS-CoV-2, through a sample collected in the respiratory tract. There are six priority groups for testing:
- patients requiring hospitalization;
- newborns and pregnant women;
- Health professionals;
- patients belonging to risk groups;
- patients who are in regular contact with people in risk groups;
- and whoever is most vulnerable at the outset – such as residents in a home or convalescing.
Before, all suspected patients were also tested for SARS-CoV-2, but as the criterion for a case to be considered suspect was more restricted, the number of tests performed was also lower. Therefore, with the new standard, those six priority groups were established, for “situations where it is not possible to test all patients with suspected COVID-19” – a rule that has not been in effect until now.
Communication with doctors through Trace-COVID
A platform called Trace-COVID was created to manage patients in self-care (that is, recovering from the disease at home) and in outpatient settings. This page is intended for use by primary care health professionals and public health teams. Until now, patients with suspected COVID-19 were registered in the National Epidemiological Surveillance System (SINAVE) and in the computer platform of each laboratory. This continues to happen, but these systems are joined by Trace-COVID.
Whoever is in self-care should be in isolation at home and be evaluated by telephone by a family health unit or by a personalized health care unit. All are submitted to laboratory tests for SARS-CoV-2 on an outpatient basis, informed of the result as soon as it is known and advised with new measures as the test dictates.
If a suspected COVID-19 patient is recovering at home, will receive an SMS that will allow you to order a test in one of the laboratories in the network identified by DGS. The laboratory must schedule the collection of samples for testing – which can be done at home or in an area reserved for COVID-19 patients in that laboratory – within a maximum period of 48 hours. In the meantime, the family doctor must contact the patient within 24 hours after contacting the SNS24 Line through the Trace-COVID platform.
If the result of the laboratory test confirms an infection with SARS-CoV-2, patients at home should remain at home o continue to comply with the official guidelines of the DGS, listed on this link. If the test result is negative, the patient must follow the instructions of the family health unit. And it will be removed from the new platform.
The way in which the patient is recovered from COVID-19 does not change. Home patients who no longer have symptoms of the disease should be tested again – and according to the same procedure mentioned in the above points – between the 10th and 14th days after the onset of symptoms. It is only considered cured if you get two negative tests done at least 24 hours apart.
Groupings create an area dedicated to COVID-19
Each cluster of health centers must create at least one dedicated area suspected or confirmed cases of COVID-19. The number of “dedicated areas” must be assessed by regional and local health authorities according to population density, geographical dispersion and epidemiological evolution in the counties concerned. You can even transform a health center into a building exclusively dedicated to COVID-19. But all of this must be communicated to the citizens; and spaces must be well signposted.
If a person with symptoms is referred to one of these centers, you must drive there in your own vehicle. If that is not possible, then an ambulance is called. Under no circumstances should public transport be used. Once in the health center, patients are evaluated to study the need to be admitted or referred to the hospital.
If there is no need for admission or follow-up at the hospital, patients are subjected to a laboratory test. These tests must be carried out in a laboratory of a network that each group of health centers creates for this purpose. From there, the procedures described in chapter 2 are followed.
All hospitals must have a special area for emergencies
Adult patients with hospitalized COVID-19 may be discharged early if a medical evaluation concludes that there is a “favorable clinical evolution”:
- if the patient has not had a constant fever for at least two days;
- if there is no respiratory failure or need for oxygen therapy;
- if the tests show that the respiratory system is not getting worse;
- and whenever the conditions are met for the patient to recover at home.
The criteria are different, and tighter, for pediatric patients with COVID-19. In addition to the “favorable clinical evolution”, only children who:
- haven’t had a constant fever for at least three days;
- there are no signs of dehydration;
- are able to swallow food or medication orally;
- and had two negative laboratory tests done 48 hours apart.
Children living with the elderly, people at risk or pregnant may not be discharged early.
All hospitals in the country and all local health units have to create a dedicated area exclusively to suspected cases of COVID-19 in emergency services, as well as wards dedicated to the treatment of patients diagnosed with the new coronavirus. The only exceptions are the Portuguese Institute of Oncology in Coimbra, Lisbon and Porto. Hospitals with pediatric services can even dedicate entire hospital units to COVID-19 only.
The standard also establishes the standard treatment to be applied to patients by COVID-19 – a treatment that was already being followed in hospitals. It starts with a “symptomatic treatment” with paracetamol and non-steroidal anti-inflammatory drugs, but corticosteroids can also be used, if the patients do not suffer from other diseases that prevent it; or antibiotics if it is suspected that there is also a bacterial infection. The latter case should only be applied after carrying out a microbiological examination.
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